National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 628579

Case Details

VAERS ID: 628579 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
   Days after vaccination:549
Submitted: 2016-02-03
   Days after onset:856
Entered: 2016-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Dizziness, Epistaxis, Fatigue, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Prophylaxis; Immunisation
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1602IRL001057

Write-up: Information has been received from Sanofi Pasteur MSD (manufacturer control # 2016000612) on 01-FEB-2016. This case was received from a consumer through health authority in a foreign country on 27-01-2016 under CA reference number: IE-HPRA-2016-025747. Initial report was received by the HRPA on 13/Jan/2016 from a member of the public which concerns a 14 year old (also reported as 12-year old) female patient who experienced syncope, fatigue, dizziness, abdominal pain and epistaxis following vaccination with GARDASIL. Concomitant medications: BOOSTRIX on 30/Mar/2012 with dose 3 of GARDASIL. Medical history/concurrent conditions: None reported. The patient was vaccinated with three doses of GARDASIL between 19/Sep/2011 and 30/Mar/2012 (batch number NP26080 (lot number NM26350, expiration date: 31-MAR-2013), lot/batch number G005669, expiration date: 31-JUL-2013 & G014520). After internal review the GARDASIL batch numbers G005669 & G014520 were corrected accordingly. (dose 1: NP26080/dose 2: G005669/dose 3: G014520). On 30/Sep/2013, the patient experienced fainting, chronic fatigue, lightheadedness, tummy pain and excessive nose bleeds that were all ongoing at the time of reporting. The reporter indicated that the patient''s fatigue may have began in Jun/2013, but as the patient was on school holidays, the long sleeps went mostly unnoticed. Corrective treatment included tests unspecified. At the time of reporting the patient was not recovered. Lot number G014520 is an invalid lot number for GARDASIL.

New Search

Link To This Search Result:

Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166